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Classing 8 8 S 8 
Book £X 



PRESENTED BY 






ju, I- / tfe. 



THE 



°Pw<k##ftl Smmam Qo, 



OF AMERICA. 



NEWARK, N. J. 



INFORMATION AND SUGGESTIONS 



-FOR THE — 



MEDICAL EXAMINERS. 



1890. 



>1 



PREFACE. 

To render the most effectual aid to a Company its Medical 
Examiners should be made acquainted with its methods of pro- 
cedure, at least in so far as these methods relate to the proper 
discharge of their duties. 

With this end in view the information and suggestions 
contained in the following pages have been given. A careful 
perusal of this manual and an observance of the suggestions 
contained therein, will, we believe, enable our Examiners to more 
readily meet the requirements of the Company. 

Information of a purely professional nature has been purposely 
omitted. The aim has been to convey, as briefly as was consistent 
with the importance of the topic, information that might prove 
serviceable to the Examiner in the daily prosecution of his duties. 

Nothing has been said about how to make an examination, 
about the knowledge to be gained by a close scrutiny of the 
applicant, about the influence of certain occupations upon lon- 
gevity, nor of the significance of certain diseases in his personal 
history. For information on these points the Examiner is referred to 
" The Medical Adviser in Life Assurance/' by Sieveking. 
''Medical Examinations in Life Insurance,'' Allen. 
••The Insurance Examiner," Stillman and works of similar 
character. 

LESLIE D. WARD, M. D., 

Medical Director. 
EDWARD H. HAMILL. M. D.. 

Medical Siqiervisor. 



CON 



N 



THE APPLICANTS. 



Actual and apparent age of 

Family history of 

Habits of 

Occupation of 

Personal history of 

Postponement of . 

Rejection of 

THE EXAMINERS. 

Accounts — when paid . 
Assignment of territory to 
Complaints against 
Communications from 
Disagreements between 
Duties to Superintendent and others 
How selected .... 

Number of 

Relation of — to applicant 

Tenure of office of ... . 



THE MEDICAL REPORTS, 

Fees for — Industrial Branch 

Fees for — Ordinary Branch . . 

Mailed to Home Office .... 

Postage on ....... 

Revivals — Industrial Branch 

Revivals— Ordinary Branch .... 

Salient points in . . 

Signatures on . 

1 Vouchers for 

When made 

The Insurance Decalogue 

TABLES. 

Combined Experience Mortality 
Expectation of Life . . ... 
Height, weight and chest expansion 
Prudential Mortuary Statistics 



PAGE. 

9 
16 
15 
13 
15 
17 
19 

5 
3 

4 
21 
3 
7 
2 
3 



7 
4 
4 
6 

22 
8 
5 
7 

24 



27 
26 
25 



INFORMATION AND SUGGESTIONS 

—FOR THE— 

mEDIGBL EXflmiNERS 

—OF— 

TEE PRUDENTIAL IMJRMgE gOMPASY 



OF AMERICA. 



The duties of a Medical Examiner are often 
arduous and always responsible. The Company, 
influenced largely by the advice of its Examiners, 
annually assumes obligations to the extent of many 
millions of dollars. Because of the responsibility 

Appointments 

attached to the position, the appointment of a made by 
Medical Examiner is invariably made by the Home 
Office. The utmost caution is exercised by the 
Medical Department to select only those who are 
professionally qualified for the duties incumbent Qualifications, 
upon them. In addition, the appointee must also 
be in good standing with his professional brethren 
and of upright life. To assure this selection, in all 
cities where three or more Examiners reside, the 
senior Examiner ( unless otherwise ordered ) is 



chairman, constituted Chairman or chief Examiner. Seniority- 
is determined by length of time in the Company's 
service. 

Whenever requested by the Home Office, the 

Chairman will recommend a new Examiner for ap- 
pointment. The rules to be observed by him are 
as follows : — 

i st. — Make nomination of new Medical Exami- 
ners only when requested by the Home Office. 

Rules govern- . 

ingtne 2d.—- Exercise care to select only those whose 

Chairman in . . 

nominating, professional qualifications you can endorse, and 
whose integrity and sobriety are beyond doubt. 

3d. — Send to the person selected a blank Medi- 
cal Examiner's application ( form 113 ) to be filled 
by him and returned to you. These application 
blanks will be found at each Superintendent's 
office. 

4th. — Correspond with his references and secure 
answers. Printed forms ( No. 355 ) for this pur- 
pose will be supplied by the Superintendents. 
Replies from at least three references are required. 

5th. — Endorse application yourself. Secure the 
signature of the Superintendent in the space pro- 
vided for that purpose. 

6th. — Be expeditious. 
Fee for A fee of $5 is paid for each selection. No 

nomination. ,.. . -. r . • -, , -, 

allowance is made for incidental expenses. 

The bill for nominating should always be ac- 
companied by the order from the Home Office 
requesting such nomination to be made. Should 
the Examiner selected fail to do the work for a 



reasonable length of time an additional selection 

should be made without expense to the Company. 

The number of Medical Examiners shall be 

Number of 

limited to as few as is consistent with a speedy ex- Examiners, 
ecution of the work assigned them. 

Each Examiner is given a certain district or 
territory in which he is expected to make all the 
necessary examinations. Instances of one Ex- 
aminer trespassing upon the field assigned to an- 
other must in all cases be satisfactorily explained. 

The examinations of applicants shall be dis- Distribution of 
tributed as equally as a due regard for seniority of 
service, distance to be covered and prompt execu- 
tion of business will permit. The territory as- 
signed to Examiners in large cities should be in 
accordance with this view. 

Differences of opinion between local Examiners 
shall be decided by the Chairman, and on appeal Disa ^ reements - 
by the Medical Director. 

No report of the examination of an applicant 
will be received at the Home Office unless made by 
one of the regular Examiners of the Company, pro- 
vided such service is available. 

The Medical Examiner holds his appointment 
during good behavior, until he resigns, changes Tenure of 
his residence so as to be no longer accessible, or is 
removed by death. 

He forfeits his position through negligence, un- 
necessary delay in making; examinations, intemper- Forfeiture of 

J J °- 7 A position. 

ance, prolonged or frequent absences and untruth- 
ful reports. 



In the friction of an active and aggressive 

business complaints will naturally arise. The 

Medical Examiner must expect his share of them. 

complaints Whenever they arise the attention of the Examiner 

made against J 

an Examiner. j s called to them. He is fully informed of their 
nature and opportunity given him to reply. De- 
cision is invariably reserved until all have been 
heard. 

The fees for examinations are fixed and paid by 
the Company. These vary with the amount and 
kind of insurance sought and the nature of the 
medical reports required. For a complete medical 

Fees for 

Examinations, report made on the Regular Industrial or white 

Ind. Branch, r b 

form the fee is 5octs. When made on Special 
Adult or blue form the fee is $1.00. No urinalysis 
is required in the above unless especially requested. 
In that event an additional fee is allowed. 

Examinations for revival of policies must be paid 
for by the persons applying for revival. The Ex- 
ExaSlSons a mm er is permitted to make such arrangements 
ind. Branch, w ^h foe Agent or Superintendent as may be satis- 
factory to himself. 

When the reports are complete they should be 
mailed direct to the Home Office in the envelopes 
mLTeddi?ec b t e provided by the Company for that purpose. These 
to h. o. envelopes are to be obtained of the Superinten- 
dents, 
postage. The Examiner must pay his own postage. 

He should use ink in writing his reports. Re- 
ports written in pencil will be returned. 



Accompanying the reports and enclosed in the 
same envelope with them should be placed the 
" Medical Referee's Voucher " properly filled out 
and signed. On the reverse side of the vouchers Ex^nSions. 
should appear the names of all the persons ex- 
amined. These vouchers will be retained and a 
weekly statement ( form 44 ) will be returned, 
showing the amount due the Examiner. The Ex- 

Weekly 

aminer's bill should be made up from the items statements, 
furnished on these weekly statements. 

If an Examiner receives applications from more 
than one Superintendent, he will be required to 
keep separate vouchers for each district. This is • 

rendered necessarv because of the work incident md. Branch. 



to the proper entry and preservation of the vouchers re- 
quired for 
vouchers at the Home Office by districts. Upon each District 

or Superinten- 

each voucher state the district or Superintendent dent, 
from whom the applications were received. Do not 
allow the names of two Superintendents or districts 
to appear upon one voucher. 

The accounts of Medical Examiners will (unless Ind M e mcai Ch * 
special arrangement is made to the contrary ) be Biu^when 
adjusted quarterly, as follows : — 

1st. — On the first Monday of each quarter the 
accounts of all Examiners residing in New York 
State will be adjusted. 

2d. — On the second Monday of each quarter the 
accounts of all Examiners residing in the State of 
New Jersey and the territory covered by the Phila- 
delphia districts. 



paid. 



Examiner's 
Accounts 
Continued. 



Fees 

Ordinary 

Branch 

Examinations. 



Ordinary- 
Branch 
Revivals. 



Ordinary 

Branch 

Examiners' 

Accts. When 

paid. 



3d. — On the third Monday of each quarter the 
accounts of all Examiners residing in Maryland, 
Delaware and Pennsylvania ( except the districts in 
Philadelphia ). 

4th. — On the fourth Monday of each quarter the 
accounts of all Examiners residing in the districts 
west of Pennsylvania. 

Blank vouchers ( Form 53 ) and Bills ( Form 
445 ) for rendering accounts will be supplied by the 
Superintendents. 

When the examination is made for the Ordinary 
Branch and the sum applied for is less than $1000, 
the fee is $2.00 for each report. When the amount 
applied for reaches or exceeds $1000, the fee is 
$3.00 for each report. When the amount applied 
for reaches or exceeds $5000, the fee is $5.00 for 
each report. Urinalysis is always required. A 
microscopical examination of the urine is not neces- 
sary, except when ordered by the Medical Depart- 
ment. When this is requested an additional fee of 
$3.00 is allowed. 

Ordinary Branch revival examinations must be 
paid for by the persons applying for revival. 

In the Ordinary, as well as in the Industrial 
Branch, medical reports must be mailed by the 
Examiner direct to the Home Office. 

Examiners' accounts with the Ordinary Branch 
will be adjusted quarterly during the first week in 
January, April, July and October. Bills reaching 
the Home Office later than either of the above 
dates will be deferred until the next ensuing 
quarter. 



Blank Bill Heads may be procured of the Super- 
intendents. 

A cardinal virtue in an Examiner is promptness 
in conducting examinations and in forwarding his 
reports at once to the Home Office. This is es- 
pecially true in Industrial Insurance. Applications, 
when handed to the Doctor, should receive im- 
mediate attention and his reports should reach us Medical 

• Reports should 

not later than the first mail on the ensuing Monday. reach 

Home Office 

In the economy of the Home Office, all reports not later than 

first mail Mon- 

arriving later than above stated are still further de- day morning, 
layed. The work in hand at the Office on Monday 
morning requires and receives attention during that 
week. It is important therefore that all medical 
reports shall be received on or before the arrival of 
the first mail on Monday. 

It is taken for granted that the Examiner will 
accord to the Superintendent the deference due him 
in his official capacity as the representative of the courteous 

treatment 

Company. Also that he will extend to the Assist- to an. 
ant Superintendents, Agents and applicants the 
courtesy due them. 

It is desirable for the Examiner to call at the 
Superintendent's, or a detached Assistant Superin- 
tendent's office, to receive applications requiring 
examination. By doing this obscure addresses and 

The Examiner 

names maybe cleared up and other information to can at 

Supt's Office. 

given that will enable him to save time and effort 
in accomplishing his work. He may arrange with 
the Superintendent the days and hours most con- 
venient to all concerned. 



Prudence will suggest the propriety of reading 

the application of each person to be examined. The 

fact of a previous rejection may be stated, or a past 

illness. It is well for the Examiner to be placed in 

The Examiner possession of such information, should it exist, be- 

should read the ... 

application, fore proceeding with his examination. Besides, if 
the signature of the applicant is omitted on the ap- 
plication, the case should not be examined, but 
returned to the Superintendent and his attention 
called to the omission. 

If an Examiner receives an application to which 
Medical the signature of the applicant has been affixed on 
vioSiy Signed the Medical Examiner's report, he should forward 
Home office the application, without examination, to the Home 
examination. Office. In no case should he proceed with the ex- 
amination. 

After the examination has been made and the 

signature of the person examined affixed to the 

medical report, it may be discovered that the two 

wrong signatures do not correspond. If the Examiner is 

Signatures ^ 

corr-cted. satisfied of this, he may secure signatures on both 

sides of the form, signing his own name as witness, 

and forward his report. In every instance of this 

kind do not fail to state the fact under " Remarks." 

Examiners ^ medical examination should never be made by 

pniy U their g own P roxv - The examiner should sign for himself 

Reports. a i one> an d only in cases he has personally examined. 

When two or more applications on the same life 

are handed to the Examiner for any current week 

he should make but one report. A single fee only 

is allowed by the Company, 



The Examiner 

and the 

Applicant. 



In proceeding with his examination the Examiner 
will bear in mind the fact that the relation between 
the Doctor and his patient differs materially from a^fp^nt. 
that which exists between the Medical Examiner and 
the applicant for life insurance. The one is eager 
to tell all his ills, and is anxious that the Doctor 
should know of every symptom and condition ; he 
speaks freely and without reserve. The other often 
desires to conceal everything that will impair the 
value of the risk or lessen his chance to effect an 
insurance upon his life. In other words, self 
interest prompts the patient to impart information, 
and the applicant for life insurance to withhold it. 

It becomes the duty of the Examiner to deter- 
mine the facts in each case he examines. He is 
employed by the Company — not by the applicant, 
nor by the Agent. He is, then, in honor bound 
to subserve the interests of the Company. 

Since our prosperty depends largely upon the in- 
tegrity with which he discharges the duties of an 
Examiner, we offer for guidance the following 

SUGGESTIONS. 

Satisfy yourself as to the identity of the appli- 
cant. The name, age, occupation, sex and signa- wentity. 
ture will enable you to do this. 

Note the apparent AGE as compared with the age Actual KaA 
given by the applicant. The conviction has been A PP arenta *«- 
forced upon the Company that there is a decided 
tendency upon the part of applicants to give ages 
younger than they really are. This is sometimes 



IO 



done, it is true, without the intent to deceive, and 
simply because the applicant, especially if of foreign 
Age continued. \^[ v ^ ; s uncertain as to his age. It is very fre- 
quently done, however, with the intent of obtain- 
ing, for a given weekly premium, as large an amount 
of insurance as possible. You will understand that 
as the age appears less the amount of insurance, 
for a stated premium, is larger. In other words, 25 
cents per week will buy more Insurance at age 40 
than at age 44. 

Again, we regret to say, that in some instances, 
the Agent, knowing this fact, and, in sharp compe- 
tition with Industrial Agents from other companies, 
endeavors to secure the applicant by promising him 
cheaper rates than he can obtain elsewhere. He 
can give this in no other way than by misrepresent- 
ing the age. In collusion, therefore, with the 
applicant he writes him up at, say 35 years of age, 
when the fact is he is 40. 

Upon the death of the insured the truth is some- 
times learned from the attending physician, whose 
certificate of $eath is submitted to the Company to 
establish the claim. 

Frequently the holder of a policy applies for ad- 
ditional insurance, giving a different age. This 
leads to investigation, and the actual age is ascer- 
tained. 

Again, Examiners sometimes detect the at- 
tempted imposition, and call attention to the 
difference between the age as given by the appli- 
cant and the apparent age. 



II 

Our statistics show that we have more policies 
in force at 40 than at 41, 42 or 43. The same result 
is shown at age 45 compared with 46, 47, 48; also Age continued - 
at age 50, as compared with 51, 52, 53. 

These figures prove that the tendency is, if 
an applicant is 41, 42 or 43, for him to give his age 
at 40, and if 51, 52 or 53 to give his age at 50, and 
so on. 

In these and other ways, as we have before stated, 
the conviction has been forced upon the Company 
that they are daily taking risks at ages younger than 
they really are. 

Let us for a moment see how important it is for 
the Company to have the CORRECT AGE at the 
time the insurance is effected. 

According to the Company's table of rates the 
amount insured at age, 40 for a weekly premium 
of 10 cents is $ 100.00 ; at age 41 the amount is 
$96.00. It therefore follows that if 100,000 per- 
sons state their ages as 40 when they are really 
41 years of age the sum insured and subject to 
loss by death is increased by $400,000. In other 
words, the Company will pay $400,000 more than 
would be paid, in the event of death, had the age 
been correctly stated. 

When it is realized that the Company insures 
100,000 persons in a short time, it becomes at 
once apparent how important it is to be exact upon 
the question of age. Next in importance to the 
physical condition } and of more i?nportance than the 



12 



Age continue 1 



Family History of the applicant, is the determina- 
tion of the Age. 

How shall the Company be protected in this 
direction ? We must look to our Medical Ex- 
aminers. 

We offer the following suggestions for your 
guidance : 

If the applicant is in doubt, or seems inclined to 
deceive, corroborative evidence can be secured, 
such as : date of emigration to this country, and 
the age at that time — the age of oldest child, and 
the age of applicant at its birth — the age of husband 
or wife — ages of brothers or sisters, living or dead, 
and comparative age of applicant with these. 

These, taken together with the apparent age of 
the applicant, will enable a judicious Examiner to 
closely approximate the actual age. Should the 
age given be one of the quinquennial periods, as 
40, 45, 50, 55, &c, take especial pains, as the 
probability is that the applicant is older. In all 
cases of doubt give the Company the benefit of that 
doubt. 

The line of enquiry, alluded to above, is briefly 
epitomized in the following verbation report from 

one of our oldest Examiners : Mrs. K applies 

for a Special Adult policy. She tells the Agent 
she is 50 years old. She also gives this age to the 
Examiner. She appears older. The report reaches 
us in this shape : " Actual age, 60. Apparent 
age, 60. Remarks : Applicant states that she is 50 



i3 

years old — does not know. the year of her birth. 
Landed in this county at 18 — married at 22 ; first 
child 2 years after marriage, who is now 36 years of 
age." 

The EXACT OCCUPATION must be stated in occupation, 
both Ordinary Branch and Special Adult Reports. 
The term laborer should not be used. Ordinary 
Branch applications upon the lives of persons en- 
gaged in the following occupations will not be 
accepted : 

Blasting. 

Mining. 

Submarine operations. 

The military or naval service in time of war. 

The manufacture, handling or transportation of 
highly explosive substances. 

The sale or handling of spirituous or malt liquors. 

Brakemen on railroad trains 

Journeyman bakers. 

Stone cutters. 

Glassblowers. 

Sailors. 

Grain handlers in elevators. 

Those engaged in the following occupations are 
received with an addition to the premium rate of 
one-half per cent, to two per cent, of the amount 
of insurance : 

Service in any capacity upon railroad trains, ex- 
cept brakeman. 

Service upon any steam or other vessel. 



Ind. Branch. 



14 . 

Engineers or firemen of stationary or moving 
engines. 

Employment in blast furnaces or foundries, &c. 
All of the above applies to the Ordinary Branch 
alone, 
occupation, The Special Adult form of application will not 
be accepted if the applicant is under 20 or over 60 
years of age next birthday ; nor if totally blind or 
deaf ; nor if either parent has died of consumption 
and the applicant is under 26 years of age next 
birthday ; nor on the lives of persons pursuing the 
the following occupations : 

Railroad Brakemen and Yardmen. 

Blasting, Mining and submarine operations. 

Manufacture of Explosives. 

Circular or Buzz Sawyers. 

Journeyman Bakers. 

Marble or Stone Cutters. 

Common Laborers. 

Glass Blowers. 

Sale or Handling of Malt or Spirituous Liquors. 

Actresses. 

Sailors. 
Note. — Grain handlers in elevators, Printers 
and Hatters will be received with caution. 

The Regular Industrial form of application will 
be received upon the lives of all persons engaged 
in any occupation whatsoever. Prostitutes and 
illegitimate children under 3 years of age are ex- 
ceptions to this rule. 



*5 



The importance of determining as accurately as 
possible the amount and kind of liquors daily con- Habits, 
sumed should be at once apparent to the Ex- 
aminer. Excessive or immoderate use invariably 
shortens life. In answering this question do not 
write " mo'derately," " occasionally," &c, but give 
average quantity each day. The term " moderate- 
ly," so often written by Examiners, may with one 
applicant mean from 20 to 30 glasses of beer and 
one or more drinks of spirits each day. To an- 
other it may mean a glass of beer or wine at meals 
only. To us, in view of the various constructions 
placed upon the word, it conveys no definite infor- 
mation of the applicant's habits. We repeat the 
request, give the average quantity and kind of 
spirits drank each day or week. 

The age, occupation and habits of the applicant 
having received attention, we now desire to call at- 
tention to the PERSONAL HISTORY. For the 
purpose of eliciting this, certain questions are ask- 
ed, to all of which the Examiner is expected to re- 
cord positive and definite answers. If a past illness 
is mentioned, such as pneumonia, pleurisy, sun- 
stroke or any other disease, it is not sufficient to 
state the bare fact, but he should also state when 
the illness occurred, the duration and severity of the 
attack ; and if more than one attack, or if more than 
one disease is mentioned, the date, severity and du- 
ration of each should be explicity stated. The Ex- 
aminer need not confine himself to the questions to 
be found on the blank provided for his use, but 



Personal 

History of the 

Applicant. 



i6 

should make such additional queries as in his 
judgement will clearly reveal all that it is desirable 
objectionable to know. Such expressions as " a cold," " over- 
work," " nervous exhaustion," " dyspepsia," "head- 
ache," &c, &c, are frequently given by applicants 
to account for an illness requiring medical advice. 
The Examiner will do well to be on his guard in 
all such cases, and make a rigid enquiry into all 
the particulars. These conditions are often prog- 
nostic of serious incipient diseases. Whenever re- 
ports of this character reach us, unaccompanied by 
evidence that the Examiner has thoroughly inves- 
tigated the point, they are returned for such inves- 
tigation. 

Next in importance is the FAMILY HISTORY. 

Family History x 

It is universally admitted that certain diseases are 
transmissible by heredity. Also, that inherited 
tendencies are most decided at certain ages. To 
properly appreciate therefore the value of a life, it is 
essential for the Examiner to know the ages at death 
and the causes of death of near relatives. Unless 
this is clearly given it will be seen that a valuable 
aid to determining the desirability of a risk is with- 
held. If the cause of death of a parent or brother 
or sister is unknown, endeavor by questioning to 
establish the existence or non-existence of heredi- 
tary disease, especially consumption. The mor- 
tality statistics of insurance companies prove that 
20 per cent, of all death claims arise from Con- 
sumption alone. 



i7 

In assigning the causes of death, avoid all in- 
definite terms, such as " asthenia," " childbirth," 
" change of life," " debility," " dropsy," " exhaus- 

... What to avoid. 

tion," exposure, failure of heart, &c. If 

it becomes necessary to use any of these terms, 
remarks, explanatory of the fact, should always be 
made, since these expressions do not establish the 
cause of death. It is possible for any one or all of 
them to exist, and yet the death may be due to 
consumption. Moreover, they are unscientific 
terms which obtain among the laity and should not 
be used by the careful Examiner. If death is 
stated to be the result of injury, accident or child- 
birth, the nature of the injury, the disease compli- 
cating childbirth and the length of time elapsing 
before death, as well as the previous condition of 
health, should be given. 

Note. — In Special Adult applications w^hen the 
applicant is under 26 years of age next birthday, 
and in Ordinary Branch applications, when the 
applicant is under 30 years of age, if the cause of 
death of a parent or brother or sister is obscure, be 
especially careful to enquire into the nature and 
duration of the last illness. Always give the age at 
death of near relatives. 

During your examination you may discover that 
the applicant is temporarily ill with an acute dis- 
ease. This would at once disqualify him for in- ^^aTcl? 
surance in the Ordinary Branch or for a Special 
Adult policy in the Industrial Branch until com- 



i8 

plete recovery has ensued. It will, therefore, be 
your duty to advise postponement of the case for 
such time as you think best. 
Postponements In the Industrial Branch (except Special Adult) 

Ind. Branch. 

a wider latitude is permissible, inasmuch as the 
policy-holder is not in benefit until 3 months have 
elapsed from the date of the policy — the Company 
assuming no liability until an applicant has been 
insured for that length of time. If the conviction 
is strong that the illness observed is mild in 
character and that its result will be determined 
within 3 months, a postponement is hardly advis 
able. We might instance an ordinary tonsilitis, an 
intestinal colic, an acute diarrhoea in a healthy 
adult, an influenza, a slight injury, such as a broken 
arm or a flesh wound, an expected accouchment, 
&c, as conditions not unfavorable to immediate 
acceptance in the Industrial Branch. If, however, 
a doubt exists in the mind of the Examiner, he 
should advise postponement for a definite period. 

After the postponement has been advised the 
Examiner need not revisit the applicant unless he 
receives from the Superintendent a new applica- 
tion. Should the application be given him before 
the postponement period has expired he should 
delay his report until the proper time. 

Cough, bronchitis, &c. are regarded with sus- 
picion, and acceptance of the risk is postponed 
until the symptoms have entirely disappeared, 



19 



Rejections are made by the Home Office for the 



r n • Rejections. 

following reasons : Wh J y made . 

Ord. Branch. 

IN THE ORDINARY BRANCH. 

i. Females under 25 or over 60. 

2. All persons under 20 or over 60 years of age. 
Exceptions to the above may be made at the dis- 
cretion of the Executive. 

3. For certain occupations see page 13. 

4. An unfavorable family history. The death 
of both parents of consumption ; the death of one 
parent of consumption, unless the applicant has 
passed the age of thirty years ; the death of two or 
more members of the immediate family (brothers 
or sisters ), unless the applicant has passed the age 
of the eldest, is usually held to be an unfavorable 
family history. 

5. An unfavorable personal history. Repeated 
attacks of " cold," bronchitis, rheumatism ; the 
history of constitutional syphilis ; excess in the use 
of intoxicants, &c, &c, are to be regarded as con- 
stituting an unfavorable personal history. 

6. The existence of disease. 

7. The maximum amount permissible under the 
rules of this Company having already been granted. 

Note. — Each Ordinary Branch Rejection Notice 
will contain a statement that the applicant will or 
will not be received in the Industrial Branch. 



20 

IN THE INDUSTRIAL BRANCH. 

Rejections. In this Branch a lower standard is attained. In- 

Why made. 

ind. Branch, creased numbers and higher rates compensating for 
a less rigid selection. 

(A) Special Adult. — Blue Form. 
i. Applicants under 20 or over 60 years of age 
next birthday. 

2. Certain occupations — see page 14. 

3. Unfavorable family history. The death of 
both parents of consumption ; the death of one 
parent of consumption if applicant is under 26 
years of age next birthday ; the death of two 
brothers or sisters, unless the applicant has parsed 
the age of the eldest. 

4. An unfavorable personal history or present 
physical condition. 

5. Excess in the use of intoxicants. 

6. The applicant having already secured the 
maximum granted on one life. 

Note. — A risk is sometimes insurable at Regular 
Industrial rates when declined at Special Adult 
rates under the above rules. In this event the 
application is modified and a Regular Industrial 
Policy issued. 

Rejections ( ^ ) REGULAR INDUSTRIAL. WHITE FORM. 

i. Applicants ( white ) under 1 year or over 
70 years next birthday. 

2. Applicants (colored) under 1 year or over 
65 next birthday. 



21 



3. Illegitimate children under 3 years of age „ . M 

«-* ° ^ J ° Rejections 

next birthday. continued. 

4. An unfavorable family history. The death 
of both parents from consumption ; the death of 
two or more brothers or sisters older than the ap- 
plicant. 

Note. — The death of one parent or one brother 
or sister is not regarded as unfavorable in this 
Branch. 

5. An unfavorable personal condition or in- 
temperate habits. 

6. The amount permissible under the Com- 
pany's rules having been already granted, further 
insurance is declined. 

It is expected of the Examiner, whenever he confidential 
shall learn of any irregularity upon the part of the ^ions? 
Agent or others who may be connected with the 
Company, that he shall acquaint the Executive 
Officers with the fact. Failing to do this he be- 
comes, in a measure, particeps criminis. To relieve 
himself, therefore, of all suspicion, he should not 
consent to remain silent when he knows that the 
rules of the Company are being violated. Should 
it be desired, any communication he sees fit to 
make will be treated as confidential in character. 
Securing applications by misrepresentation, false 
promises to prospective policy-holders, " quiet 
business," rewriting rejections for sums that do not 
require medical examination, stating the wrong 
occupation, &c, are some of the violations of rules 
that may come under his observation. 



s iai com Special communications, bearing upon cases that 
munications. j ie ma y ] iave examined, will be very gladly received, 
inasmuch as they throw greater light upon such 
cases and enable us to act more intelligently. This 
is especially desirable where rejection has been 
made and request to reconsider has been received. 
The equipment of a medical education by any 
one of the reputable Medical Colleges of the coun- 
try presupposes an ability to properly examine 
an applicant, 
salient points The points to be determined in a medical report 
m Rep e o d A c . al on a life are as follows : 
i. The age. 

2. The habits. 

3. The family history. 

4. The occupation. 

s 5. The personal history. 

6. The health of the applicant. 

The first five above named have already received 
attention. In determining them the Examiner has 
of necessity been compelled to trust to statements 
made to him, and only partially, perhaps, corrobo- 
rated- by his own observation and enquiry. Upon 
the last and most important point the Examiner is 
at an advantage. The subject is before him — un- 
der his immediate and personal investigation. 

He brings to bear the skilled tools of his craft — 
an observant eye, a quick ear, a skilled touch. 
The existence of disease should not escape his 
notice. His report on this point should be 
accurate. Here there is the least excuse for error. 



23 

It is unnecessary to suggest how the examination 
should be conducted. That is already known if 
the Examiner is what he professes to be — an educat- 
ed physician. 

The Ideal Medical Examiners report embraces in The ideal 

Medical Report 

terse concise terms a pen picture of the applicant. 
Nothing important is omitted. Nothing unimport- 
ant is inserted. It is recognized at once as the pro- 
duction of a thorough physician, It reflects credit 
upon the writer and begets confidence at the Home 
Office in his examinations. It inspires respect for 
his opinion and gives increased weight to his 
judgment. 



Attention is called to the ten rules given on the 
following page. They may be aptly called 

The Insurance Decalogue. 
• They briefly epitomize the instructions already 
given. 



24 

THE INSURANCE DECALOGUE. 



The Examiners 
Decalogue. 



i. Examine promptly. 

2. Answer each question definitely, and use 
ink in writing. 

3. If consumption is recognized as a cause of 
death in near relatives, give a full family history, 
number of family living, number dead, ages at and 
causes of death. 

4. Avoid indefinite expressions in assigning 
causes of death or naming a past illness. 

5. Explicit information of past illness of 
serious import — number of attacks — date of last — 
duration and severity. 

6. If suspicious of intemperate habits or ( in 
case of females ) immoral life, enquire closely and 
give your conclusions. 

7. Give exact age. 

8. State present occupation. If recently 
changed give previous occupation. 

9. Notify the Company of any irregularity. 
10. Mail your reports so that they will reach 

the Home Office not later than the following 
Monday morning. 



2 5 



TABLE OF HEIGHT AND WEIGHT AND CHEST EXPANSION. 



NORMAL PROPORTION OF THE HEIGHT OF INDIVIDUALS 

TO THEIR WEIGHT AND CHEST 

MEASUREMENT. 



HEIGHT. 


WEIGHT. 


CHEST MEASUREMENT. 


Max. 


Med. 


Min. 


Full 
Inspiration. 


Full 
Expiration. 


4 feet 10 in. 


150 


105 


83 


31.5 in. 


29.5 in. 


4 < 


• 11 « 


160 


110 


87 


32.6 " 


31.3 " 


5 < 


' 


167 


115 


92 


33.2 " 


31.9 " 


5 ' 


1 " 


174 


120 


96 


34.8 " 


32 2 " 


5 < 


, 2 " 


181 


125 


100 


35.5 " 


33.0 " 


5 < 


' 3 " 


188 


130 


104 


35.8 " 


33.4 " 


5 ' 


4 " 


195 


135 


108 


36.4 " 


33.9 " 


5 < 


5 < ; 


200 


140 


112 


36.7 " 


34.0 il 


5 ' 


« 6 « 


205 


145 


115 


37.0 " 


34.5 " 


5 < 


7 " 


210 


150 


120 


37.4 " 


34.7 " 


5 ' 


8 " 


215 


155 


125 


38.0 " 


35.1 " 


5 ' 


9 " 


220 


160 


130 


38.9 " 


35.7 " 


5 < 


10 " 


225 


165 


135 


39.0 " 


36 " 


5 < 


11 " 


230 


170 


140 


39.8 " 


36.7 il 


6 ' 


c< 


235 


175 


145 


40.3 " 


37.2 " 


6 " 


1 <f 


240 


180 


150 


41.0 " 


37.6 " 


6 ' 


2 " 


245 


185 


155 


41.9 " 


38.2 " 


6 < 


3 ' 


250 


190 


160 


42.6 " 


38.9 " 


6 " 


4 " 


255 


195 


165 


43.5 " 


39 6 i( 



Thi© above Table is not intended for abosolute 
guidance, but for reference. 



26 



EXPECTATION OF LIFE, 

Constructed, from the Combined Experience Mortality Table. 



Years 


Expectation 


Years 


Expectation 


Years 


Expectation 


Old. 


Years. 


Old. 


Years. 


Old. 


Years. 


10 


48.3 


40 


27.2 


70 


8.5 


11 


47.6 


41 


26.5 


71 


8.1 


12 


47. 


42 


25.8 


72 


7.6 


13 


46.3 


43 


25.1 


73 


7.2 


14 


45.6 


44 


24.4 


74 


6.8 


15 


44.9 


45 


23.6 


75 


6.4 


16 


44.2 


46 


22 9 


76 


6.1 


17 


43.5 


47 


22.2 


77 


5.7 


18 


42 8 


48 


21.5 


78 


5.4 


19 


42.1 


49 


20.8 


79 


5. 


20 


41.4 


50 


20.1 


80 


47 


21 


40.7 


51 


19 5 


81 


4.4 


22 


40. 


52 


18.8 


82 


4.1 


23 


39.3 


53 


18.1 


83 


3.9 


24 


38.6 


54 


17.5 


84 


3.6 


25 


37.9 


55 


16.8 


85 


3.3 


26 


37.2 


56 


16.2 


86 


3.1 


27 


36 5 


57 


15.5 


87 


2.8 


28 


35 8 


58 


14.9 


88 


2.5 


29 


35.1 


59 


14.3 


89 


2.3 


30 


34.4 


60 


13.7 


90 


2.1 


31 


33.7 


61 


13.1 


91 


1.8 


32 


33. 


62 


12.6 


92 


1.6 


33 


32.3 


63 


12. 


93 


1.4 


34 


31.5 


64 


11.5 


94 


1.2 


35 


30.8 


65 


10 9 


95 


1.1 


36 


30.1 


66 


10 4 


96 


.9 


37 


29.4 


67 


9.9 


97 


.8 


38 


28.7 


68 


9.4 


98 


.7 


39 


28. 


69 


9. 


99 

| 


.5 



Long and carefuP observation has shown, that notwithstand- 
ing the life of any given individual is proverbially uncertain, yet, 
that if a large number of persons in ordinary circumstances at a 
given age be taken, there is a law, fixed and uniform, determining 
within very narrow limits, the average number of years remaining 
to them. For example, if we take 10,000 persons at the age of 32, 
the sum of their ages at death will amount to about 330,000 years ; 
showing that, on an average, each person 35 years old will live 33 
years longer. This mean after lifetime is called the expectation 
of life at the assured age, that is, the number of years which one 
at that age may expect probably to live. 



COMBINED EXPERIENCE MORTALITY TABLE. 



27 





Number 


Deaths 


Deaths 




Number 


Deaths 


Deaths 


AGE. 


surviving: 
at each 


in each 


per 


AGE. 


surviving 
at each 


in each 


per 





Age. 


Year. 


1,000. 




Age. 


Year. 


1,000. 


143,400 


22,184 


154.700 


50 


69,517 


1,108 


15,938 


1 


121,216 


7,697 


63,498 


51 


68,409 


1,156 


16,898 





113 5 9 


4,030 


35,501 


52 


67,253 


1,207 


17,1*47 


3 


109 489 


2,617 


23,902 


53 


66,046 


1.261 


19,093 


4 


106,872 


1,892 


17,703 


54 


64,785 


1,316 


20,313 


5 


104,980 


1,428 


13,603 


55 


63,469 


1,375 


21,664 


6 


103,552 


1,123 


10,845 


56 


62,094 


1,436 


23,126 


7 


102.429 


922 


9,001 


57 


60,658 


1,497 


24,679 


8 


101,507 


792 


7.802 


58 


59,161 


1,561 


26,386 


9 


100,715 


715 


7,099 


59 


57,600 


1,627 


28,246 


10 


100.000 


676 


6,760 


60 


55,973 


1,698 


30,336 


11 


99.3 ^4 


67'4 


6,786 


61 


54,275 


1,770 


32,612 


12 


98,650 


672 


6,812 


62 


52.505 


1,844 


35,121 


13 


97.978 


671 


6,848 


63 


50 661 


1,917 


37,840 


14 


97,307 


671 


6,896 


64 


48.744 


1.99) 


40,856 


15 


96,636 


671 


6,944 


65 


46,754 


2,061 


44,082 


16 


95,965 


672 


7,0 \3 


66 


44,693 


2,128 


47,614 


17 


95,293 


673 


7,062 


67 


42,565 


2,191 


51,474 


18 


94,620 


675 


7,134 


68 


40,374 


2,246 


55,630 


19 


93,945 


677 


7,206 


69 


38,128 


2,291 


60,087 


20 


93,268 


680 


7,291 


70 


35,837 


2,327 


64,933 


21 


92,588 


683 


7,377 


71 


33,510 


2,351 


70.158 


22 


91,905 


686 


7,464 


72 


31,159 


2,362 


75,805 


£3 


91,219 


690 


7,564 


73 


28,797 


2,358 


81,884 


24 


90,5'29 


694 


7,666 


74 


26,439 


2,339 


88,468 


25 


89,835 


698 


7,770 


75 


24,100 


2.303 


95,560 


26 


89,137 


703 


7,887 


76 


21,797 


2,249 


103,180 


27 


88,434 


708 


8,006 


77 


19,548 


2,179 


111,409 


28 


87,726 


714 


8,139 


78 


17,369 


2,092 


120,444 


29 


87,012 


720 


8,275 


\9 


15,277 


1,987 


130,065 


30 


86,292 


727 


8,475 


80 


13,290 


1,866 


140,406 


31 


85,565 


734 


8,578 


81 


11,424 


1.730 


151,436 


32 


84.831 


742 


8,747 


82 


9.694 


1,582 


163,194 


33 


84,089 


750 


8,919 


83 


8,112 


1,427 


175,913 


34 


83,339 


758 


9,095 


84 


6,685 


1,268 


189,678 


35 


82,581 


767 


9,288 


85 


5,417 


1,111 


205,095 


36 


81,8 4 


776 


9,485 


86 


4,306 


958 


222,480 


37 


81,038 


785 


9,687 


87 


3,348 


811 


242,234 


38 


80,253 


795 


9,906 


88 


2,537 


673 


265,274 


39 


79,458 


805 


10,131 


89 


1,864 


545 


292,382 


40 


7 a ,653 


815 


10,362 


90 


1,319 


427 


323,730 


41 


77,838 


826 


10,612 


91 


892 


322 


360,987 


42 


77,012 


839 


10,894 


92 


570 


231 


405,263 


43 


76,173 


857 


11,251 


93 


339 


155 


457,227 


44 


75.316 


831 


11,697 


94 


184 


95 


516,304 


45 


74,435 


909 


12,212 


95 


89 


52 


584,270 


46 


73.526 


944 


12,839 


96 


37 


24 


648,649 


47 


72,582- 


931 


13,516 


97 


13 


9 


692,308 


48 


71.601 


1,021 


14,260 


98 


4 


3 


750,000 


49 


70,580 


1,063 


15,061 


99 


1 


1 


100,000 



Ages O to 9 Fackler's Extension. 



28 



The following Table, taken from the Mortality Register 
of The Prudential Insurance Company of America, gives 
the number of deaths from each cause to 10,952 deaths from 
all causes occurring among Policy-holders of the Company, 
from June, 1887 to July 1st, 1888. 

Order No. 1 .—Miasmatic. 
Diptheria, 
Croup, 
Scarlatina, 
Typhoid Fever, • 
Dysentery, 
Typho Mai. Fever, 
Puerperal Fever, 
Diarrhoea, 
Pyaemia, 
Cholera Morbus, 
Cerebro Spinal Fever. 
Remittent Fever, 
Cholera Infantum, - 
Measles, - 
Whooping Cough, - 
Erysipelas, 
Smallpox, 

Intermittent Fever, 
Congestive Fever, - 
Carbuncle, 
Yellow Fever, 
Typhus Fever, 
Quinsy, 
Goitre, 
Mumps, 
Varicella, 

Order No. 2.— Enthetic, 
Syphilis, 
Rabies, 

Order No. 3.— Dietic 
Purpura Hemorrhagica, 
Alcoholism, 
Lead Poisoning, 



co 

P: 



2 9 



5 
5 



<o 



CO 

CO 
CO 



CO 



CO 

3 

CO 



CO 
CO 



Cancer 

Rheumatism, 

Anaemia, 



Order No. 1 



Order No. 2. 



-Diathetic. 



Tubercular. 



—Nervous. 



Consumption, 
Tubercular Meningitis, 
Tabes Mesenterica, 
Other Tubercular Diseases, 
Scrofula, • 
Miliary Tuberculosis, 
Rachitis, - 

Order No. 1 
Apoplexy, 
Encephalitis, 
Paralysis, 
Convulsions, 
Congestion of Brain, 
Insolation, 

Softening of Brain, • 
Epilepsy, - 
Insanity, 
Myelitis, 
Tetanus, 
Tumor of Brain, 
Locomotor Ataxia, - 
Embolism, 
Effusion of Brain, 
Abscess of Brain, 
Spinal Sclerosis, 

Order No. 2.— Circulatory. 
Valv. Disease of Heart, 
Diseases of Heart not specified 
Hypertrophy of Heart, 
Fatty Degen. of Heart, - 
Pericarditis, 
Endocarditis, 
Angina Pectoris, * - 
Aneurism, 



322 

43 
24 

1966 
85 
62 
19 
14 
4 
1 

371 

285 

147 

119 

76 

52 

42 

27 

24 

22 

8 

7 

7 

4 



388 
118 
68 
61 
51 
44 
29 
24 



Embolism, 
Paralysis of Heart, 
Phlebitis, 



12 
3 

1 



Order No. 3.— Respiratory. 



Pneumonia, 
Bronchitis, 
Pleurisy, 

Congestion of Lungs, 
Asthma, 

Hemorrhage of Lungs, 
Laryngitis, 
Oedema of Lungs, 
Emphysema, 
Abscess of Lungs, 
Oedema of Larynx, 
Ulcer of Larynx, 
Gangrene of Larynx, 



Order No. 4.— Digestive. 



Peritonitis, - 

Enteritis, 

Cirrhosis of Liver, 

Gastritis, 

Gastro Enteritis. 

Hepatitis, 

Dropsy of Liver, 

Obstruction of Intestines, 

Ulcer of Stomach, 

Strangulated Hernia, 

Fatty Degeneration of Liver, 

Jaundice, 

Perityphlitis, 



1147 

360 

61 

58 

41 

29 

17 

13 

13 

12 

3 

1 

1 



125 

115 



95 
59 
45 
45 
35 
21 
20 
10 
10 



CO 

<5> 



31 

Hemorrhage of Stomach, ----- 8 

Stricture Oesophagus, ----- 8 

Hypertrophy of Liver, .... 8 

Abscess of Liver, * 7 

Disease of Liver, - - - - 6 

Congestion of Liver, ...... 5 

Tumor of Abdomen, ------ 5 

Ulcer of Intestines, - 4 

Hemorrhage of Intestines, ----- 3 

Calculus of Liver, ..... 3 

Leucocythaemia, - 3 

Colic, -.----. 2 

^; Fistula in Ano, ------ 2 

§ Disease of Spleen, ..__-_ 1 

§ Perforation of Intestines, ----- 1 

1 
co Order No. 5.— Urinary. 

ki 
co 

^ Bright s Disease, ...... 575 

5 Diabetes, ------- 29 

^i Cystitis, --..-.. 26 

Congestion of Kidneys, ----- 3 

Abscess of Kidneys, ..... 2 

Tumor of Kidneys, ------ 2 

Fatty Degen. of Kidneys, .... 1 

Gravel of Kidneys, -..-._ 1 

Order No. 6.— Generative. 

Hemorrhage — Uterine, - 13 

Tumor — Ovary, - - - - - 12 

Pelvic Cellulitis, --.-.. 4 

Tumor of Uterus, - • - - - - • 3 

Metritis, ------- 3 

Vaginitis, ...... . 1 



3* 



co 



Order No. 7.— Locomotory & Osseous. 
Curvature of Spine, - 
Hip Disease, ..... 

Arthritis, ...--- 

Order No. 8.— Integumentary. 
Abscess, ...... 

Eczema, ...-.- 

Lupus. ------ 

Order No. 2.— Women. 
Puerperal Convulsions, ... - 

Childbirth, ..... 

Pregnancy, ------ 

Puerperal Mania, .... 

Placenta Previa. - 



Order No. 3.— Old Age. 



Old Age, - 
Senile Gangrene, 



Deaths, 



cos* 



co to 

24 



Order No. 1-4.— Violent Deaths. 



Order.— Imperfectly Defined. 



Deaths, 



11 

10 

3 

14 
1 
1 

39 

13 

4 

2 
2 

230 
24 

434 

81 



^) 1 l|^ 1 j|i 

SUMMARY. 




ZYMOTIC, 


2,363 


21.57 


CONSTITUTIONAL, 


2,540 


23.19 


LOCAL, 


5,220 


47.67 


DEVELOPMENTAL, 


314 


2.87 


VIOLENCE, - 


434 


3.96 


IMP. DEFINED, 


81 


.74 



Males, 5,469. 



10,952 100.00 

Females, 5,483. 



CbH}. ffi"MP TO-P AY. /t ff. 

The Insurance Company Would Not Settle 
in This Case. 

Some two weeks ago, "Mickey" Con- 
nors, one of the agents of the Metropoli- 
tan Life Insurance Company, wrote, it is 
alleged, a SlO'Qjiglicjr for Barnard McMa- 
hon, the infant son of Mr. and Mrs. Pat- 
rick McMahon. ^.t that time it is claimed 
the child was examined "by the company's 
physician, and found it is said to he per- 
fectly healthy. The policy was delivered 
by Connors last Monday. The child died 
of cholera infantum en Tuesday. When 
the application was made yesterday for 
the insurance due, the company, it is 
claimed, through its\agent, Connors, re- 
fused to pay saying that the child's dying 
so soon after the policy was delivered made 
it'void. It is possible that the matter 
may be settled in the courts. 






. 



LIBRARY OF CONGRESS 



027 292 782 



